Bystolic - New Beta Blocker

[yogini]

At my dr's appointment today, he mentioned that they have a new patient with the "worst case of POTS ever" and that they have been doing a lot of reading about POTS. (This is a relatively new dr for me and I was like WAIT, doctors actually read for their patients?!? ) But anyway, as an option to Paxil he suggested a new beta blocker called bystolic which supposedly has fewer side effects than the usual beta blockers. I put it off for now, because I'm trying Paxil, but this is something I may try in a few months. I'm wondering whether any of you have heard of it or tried it? I haven't seen it mentioned on the forum before. I do think it's exciting to have the possiblity of this new med, since many of us can't tolerate BBs or have to live with the side effects.

He said that the one caveat was that since it was new, insurance might not cover it. I am going to call my insurance company to find out whether it is covered, just out of curiousity. Another concern that I would have is that is is a new drug - unlike good old atenolol which has been around for ages - which is why I wanted to check in here. I did read a bit on the web, but it's mostly PR from the drug companies.

[Sophia3]

Never heard of it.

But my philosophy is NEVER use a brand new drug that is on the market LESS than 5 years. Too many things rushed to market now. Safety is NOT a priority until they get 'enough complaints' once things are on the market.

So, I an leery of anything 'brand new' but that's just me.

A good friend of mine has a brother who is a drug rep and he agrees that things are 'rushed to market.'. THIS coming from a guy that makes HUGE bucks doing little work except shmoozing with doctors/offices and taking doctors out to nice restaurants!? and getting big bonuses and free vacations. Oh, and those are his words he does little work for the money. He drives a lot and works a good 40 hr week but he still says it's cake walk compared to most jobs. He pushes some purple pill for stomach problems or somethingg.

Risks of unknown are not worth it to me. Most meds that help me or to try that don't help me have been around for at least 10 years. Most for decades.

[yogini]

Sophia,

I agree with some of your concern. I saw a story on 60 Minutes the other day which was about an anti clotting drug which caused 1000 deaths/month for a couple of years before it was caught, On the other hand, there are some new drugs which have been used safely overseas for a long time before they come tothe US and others which are just a variation of existing drugs - this might make me more willing to try them. I just want to find out the full story - mechanism, history, etc. And if even if we waited, it could mean something for POTS patients down the road, which is good news.

[flop]

I'm always interested in new drugs (and had never heard of Bystolic) so I've done a bit of research on the internet this afternoon. It turns out that this med is new to America (FDA approval granted on 18th February 2008). But it is not a new medication to the rest of the world. Its generic name is Nebivolol (brand names include Nebilet, Nebilong, Nebicard, Nodon, Lobivon and Nubeta). I have found journal articles about it dating back to 2001. when I think it first became available in Europe.

Nebivolol is a selective beta-1 blocker (it has more action on beta-1 rather than beta-2 receptors). This means that is is more selective at targeting the beta receptors in the heart and blood vessels rather than the ones in the lungs which can cause bronchospasm and wheeze. Other beta-1 selective meds include Atenolol, Bisoprolol and Metoprolol.

Nebivolol also causes arteriolar vasodilation (it widens the small arteries) this lowers the resistance in the blood vessels and is one of the mechanisms by which it lowers blood pressure.

The most common use of Nebivolol in the UK is in the management of stable heart failure (Bisoprolol and Carvedilol are the other beta-blockers used for treating heart failure).

I've cut & pasted the following paragraph from Wikipedia:

Nebivolol lowers blood pressure (BP) by reducing peripheral vascular resistance, and significantly increases stroke volume with preservation of cardiac output.[1] The net hemodynamic effect of nebivolol is the result of a balance between the depressant effects of beta-blockade and an action that maintains cardiac output.[2] As well as being an effective antihypertensive treatment, nebivolol is not associated with many typical beta-blocker related side effects, such as fatigue, clinical depression, bradycardia, or impotence.

I'm not sure that the vasodilating property of Nebivolol will make it particularly useful in POTS but it would be interesting to hear from anyone who has tried it. Possibly the increased stroke volume (amount of blood pushed out of the heart when it beats) might compensate for the vasodilatation? It seems that we are after a medication that slows heart rate without dropping blood pressure but Nebivolol seems to do the opposite?

Flop

[Sophia3]

Oops..left out a key comment.

If a drug has been used in OTHER countries for years and then added to our meds, that is ok. It's been on the market and out into the masses for general use.

Either midodrine or DDAVP was used in other countries before being ok'd here.

I am talking drugs BRAND NEW out of research in general.

Sorry for leaving out a comment, I thought I had left in. Too much editing of myself methinks.

[yogini]

Thanks, Flop. It's funny that it just came out last week in the US - talk about new! Based upon your description it doesn't seem like it would be helpful. I'm glad I opted for the Paxil. But the literature says. and my dr seemed to think, that the advantage of bystolic is that it has far fewer side effects - fatigue, exercise intolerance, etc. The stats reported in some of the articles online for negative side effects seem low (i..e 5% for fatigue), but they are very scientific and not sure I am interpreting them correctly. I'd still be curious to see where this goes and if any of our friends in Europe has tried it.

[flop]

Hi Rita,

I wasn't trying to suggest that it wouldn't work in POTS - just me thinking out loud about different properties of the meds. Maybe it would work through the increased stroke volume to keep blood flowing more quickly?

If anyone has tried it please feedback - it would be interesting to hear how it works in real life.

Flop

[ajw4790]

This is interesting and would be good to know if anyone has tried it.

[kwalk]

my doctor just switched me from propanolol to bystolic, it brings down my heart rate just as well as propanolol for me atleast. I was really surprised she mentioned the drug as an option since it's new, and as I already researched it, I chose that one right away!

The first day my heart rate dropped about 30 points.(standing I am about 150- 120 immediately) I felt like I was falling asleep all day on propanolol, where as with this one I do notice a definite change in energy.

On the second day I had a record of having a heart rate of 74. Now, usually after a few hours of taking bystolic, I am in the lower 90's.

Another thing I really enjoy is that I only have to take it once a day. I'm extremely forgetful with the doses I have to take that are not in the morning or at night. Thankfully it's just salt pills for me now, so it's not a huge deal if I forget at the time, I just usually remember a few hours later

I will let you all know how my progress goes with it.

[jbrian00]

Are you saying the your hr is slowly increasing since you've been on bysolic (since you said it went from 74 to lower 90s)? I'm assuming this is when sitting and not standing. How does it compare now with the propanolol? I'm wondering if it will take a little while for your body to adjust from the propanolol to the bystolic, since it's used to having its other beta receptor blocked. So we will see if your hr remains under control with bystolic. Hope it does. Good luck!

[kwalk]

you have a point there- the past few days it's been ranging all over in the lower numbers, and it seems to be not as effective after I first took it. That might have happened with propanolol too and after awhile we saw it go down much lower and be more steady. I'm really bad at noticing patterns though and keeping track of things, no matter how hard I try, I get so off task. Anyways, I have noticed since I started taking it, everyday it looks like it takes more hours to see an effect from it, where as before I noticed the effect happened much quicker like an hour after taking it. i have a feeling that might mean I need to go up on the dose, as my doctor said when she first gave it to me, but wanted to start low.

[deucykub]

I started on Bystolic last Friday.

My doctor has done incredible amounts of research to try and help my high heart rates while not exacerbating my asthma. Since Bystolic is highly selective to the B1 receptors, we decided to give this medication a very cautious try. I'm monitoring myself closely for drops in BP or recurrence of my asthma (which has been quiet for 2 years now). We've started at half of the smallest available dosage, currently taking 1.25 mg, which we plan to double each week to find my optimum dose.

So far, I have not had any problems with asthma. My fatigue however seems to be worse, even when taking a full 100 mg Provigil (I was cutting them in half and taking 50 mg most days). I've found myself just staring at my computer trying to get my brain to work, but I don't seem to "come to" until late afternoon.

My doctor said I should take this medication in the morning for maximum effectiveness, but I'm wondering if taking it at night my give me enough effectiveness during the day while preventing the drowsiness it's causing - perhaps even helping me sleep! Does anyone take Bystolic or another beta-blocker at night? Does that work well for you?

The results are still inconclusive - my vitals prior to Bystolic were around 110/80 sitting and standing and 100 and 130 sitting and standing, respectively. My last reading before Bystolic was 103/79 and 157 standing.

On bystolic: 120/67 and 65 sitting to 103/67 and 109 standing.

[Guest brianala]

Does anyone take Bystolic or another beta-blocker at night? Does that work well for you?

I take my beta blocker around dinnertime, and when I asked my cardiologist if there was anything I could do about my fatigue/energy levels she suggested taking it at night (which I am already doing). I've never taken it in the morning so I don't have much to compare with, but I find that I still have palpitations within a few hours before and after taking it, and especially right as I'm trying to get to sleep.

[lizzyp]

A friend who also has POTS takes Bystolic. She has been on it I am guessing around 9 months or longer. She said it works well for her. Her blood pressure stays down but it isnt too low. She has been very happy with it. She has also tried many other meds along the way and hasnt found anything that helps or works for her as well as this one does. I asked my Dr. about it for me personally and he at the time was worried about my blood pressure being too low if I were to take it. I take Metoprolol ER 25mg.

[deucykub]

Thanks for your replies!

I gave it a try last night, and my energy level seems to be higher than when I took it in the morning. My heart rate is still pretty low today (at least sitting) at 75.

My doctor was worried about Bystolic's effect on BP for me, too, but given that Propanolol had caused a severe, persistent asthma attack in the past, it was the only option left to get my heart rate under control. We've just been monitoring it pretty closely, while starting at ridiculously low dose.

That's interesting you should mention palpitations when taking a BB at night. I had the same thing; although I was sure if it was because of the night dose or my overworking this week.

[yogini]

I just got a script for bystolic. I'd been taking atenolol for years. I weaned down to 1/8 pill last summer and then weaned off of it in January. Since weaning, I've noticed my HR gets high sometimes. The problem is that even when I take 1/8 pill atenolol, I feel dizzy and tired. So I am going to try bystolic as needed.

The pharmacy was out of the 2.5 mg pills my doc prescribed. I tried a fraction of the 5mg sample the dr gave me and so far I feel a little funny in the head and my HR is slower. We will see how I feel tomorrow! If it doesn't make me too tired, I may go back to taking it every day...

[iheartcats]

I'm seeing my EP next week so I sent him a note about this. My heart rate has been out of control and wearing me down. I'm on Midodrine, but that's not helping too much.

My allergies have been acting badly (which in turn leads to breating/asthma issues if I'm not careful) so not on the Mestinon right now.

Is this a 'safer' Beta to take with asthma? My asthma has been under control for years (it's the allergies I have to keep in control)...

So any updates you guys have in the next week, post away, and I'll let you know what my EP says next week.

Do any of you take this with Midodrine?

[yogini]

When I woke up this morning, I saw spots all over the walls. I think this was a side effect of the bystolic. It went away after I closed my eyes after a few minutes. Other than that I felt normal. I'll try it again the next time I'm tachy.